Cardiac Adverse Events after Vaccination—A Systematic Review

Abstract

The Vaccine Adverse Event Reporting System database has been used to report adverse events following several vaccines. We studied the patient population predisposed to such reactions and how these reactions differ with respect to the vaccine type. We searched the electronic databases PubMed, EMBASE, and Scopus up to 9 July 2021 for any study describing cardiac adverse events attributed to the vaccination. A total of 56 studies met the criteria comprising 340 patients. There were 20 studies describing cardiac adverse events following smallpox vaccination, 11 studies describing adverse events after influenza vaccination, and 18 studies describing adverse events after COVID-19 vaccination. There was a total of six studies describing cardiac adverse events after the pneumococcal vaccine, tetanus toxoid, cholera vaccine, and rabies vaccine. Adverse events following influenza vaccination occurred more commonly in older females within an average duration of four days from vaccination. Pericardial involvement was the most reported adverse event. Adverse events following COVID-19 vaccination happened at a mean age of 42.7 years, more commonly in males, and mostly after a second dose. Adverse events following smallpox vaccination occurred more commonly in younger males, with an average onset of symptoms from vaccination around 16.6 days. Adverse events were mostly myopericarditis; however, the acute coronary syndrome has been reported with some vaccines.

Covaxin-Induced Lymphocytic Myocarditis

“…A case report of hyper-eosinophilic syndrome with myocarditis in a healthy young adult male following Covaxin vaccination has been described previously [7]. Similarly, prior reports have linked myocarditis to different vaccinations, including smallpox and influenza [8,9]. The underlying etiology is thought to be provoked by an autoimmune response in the setting of molecular mimicry versus a nonspecific inflammatory process [10,11].…”

Comparison of COVID-19 Vaccine-Associated Myocarditis and Viral Myocarditis Pathology

“…Sympathetic dysregulation, cross-reactivity of immunogenic components, and genetic sensitivities of the immune system have all been implicated in its development [ 145 , 146 ]. In the case of the smallpox vaccine, a dysregulated inflammatory response due to small genetic variations in interleukin-4 (IL-4) leads to the adverse effects seen in some patients post-vaccination [ 5 , 146 , 147 , 148 ]. IL-4 is produced by Th2 cells, stimulates Th2 cell differentiation, and is active in anti-inflammatory pathways that attenuate inflammatory macrophage responses [ 149 ].…”

“…Genetic variants of interleukin-18 (IL-18) and interleukin-1 (IL-1) with increased sensitivity were also elevated in some post-vaccine immune responses [ 5 ]. Influenza vaccines are far less likely to cause myocarditis, but rare reports have been made [ 145 , 148 , 150 , 151 ]. Current evidence favors a hyperactive response to an adjuvant, consistent with ASIA.…”

Vaccine‐Triggered Acute Autoimmune Myocarditis: Defining, Detecting, and Managing an Apparently Novel Condition

“…It also seems likely that immunizing therapies other than mRNA vaccines can trigger myocardial inflammation when given to susceptible populations; perhaps notably, the myocarditis following smallpox vaccination also appears to favor young male subjects. 20 …”